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SCHOOL VISION REFERRAL Dear Parent×Guardian, Date School vision screening test, recently performed at, indicate that your child, was tested (with glasses×contacts on) and did not pass the screening.

How to fill out school vision referral

How to fill out a school vision referral:

1. Start by gathering all relevant information about the student, such as their name, grade, and contact details. This information is crucial for proper identification and communication.
2. Next, provide a detailed description of the student's vision concerns or issues. Include any specific symptoms or difficulties they may be experiencing, such as blurry vision, eye strain, or trouble focusing.
3. Specify if the student has had any previous vision screenings or eye exams. Include the dates and results of these screenings, if available. This information will help determine the continuity of care and establish a baseline for the student's visual health.
4. If the student wears glasses or contact lenses, indicate this in the referral form. Include the prescription details, such as the power and any additional special requirements. This information will guide the healthcare provider in assessing the student's current visual correction needs.
5. Additionally, provide any relevant medical history, including past eye conditions or treatments. If the student has been diagnosed with any eye-related disorders or has undergone eye surgeries, it is crucial to include this information for a comprehensive evaluation.
6. The referral form should also contain the name and contact details of the referring person, whether it is a teacher, school nurse, or another school staff member. This allows the healthcare provider to reach out for further clarification or updates if needed.

Who needs a school vision referral:

1. Students who are experiencing visual difficulties or exhibiting symptoms that may indicate underlying vision problems. This includes blurriness, double vision, eye strain, headaches, or difficulties focusing during school work.
2. Students who have failed previous vision screenings or have not undergone a vision screening in an extended period. Regular vision screenings help identify potential vision issues that may affect a student's learning and overall academic performance.
3. Students with a known history of eye conditions or disorders that require ongoing monitoring or management. This includes conditions such as amblyopia (lazy eye), strabismus (crossed eyes), or any other congenital or acquired eye diseases.
4. Students who wear corrective eyewear, such as glasses or contact lenses, and require regular check-ups and prescription updates. Regular vision referrals ensure that the student's visual correction needs are appropriately addressed and optimized for their academic success.

Remember, a school vision referral plays a crucial role in ensuring that students receive the necessary vision care and support to succeed academically. By accurately filling out the referral form and identifying who needs it, we can ensure that students' visual health and well-being are prioritized.

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